Patient Protection and Affordability Care Act (ACA) 2014 – Health Net

Health Net recently released a number of changes in coverage effective as of January 2014 as the result of the Affordability Care Act.  Here are some of the changes that may affect you.

Guaranteed availability of insurance.

Requires guarantee issue and renewability of health insurance for individuals and business groups.  Prohibits annual dollar limits on coverage for Essential Health Benefits.

Allows rating variation in the individual and small group market and Health

Insurance Exchanges based only on:

•  Age – limited to a 3:1 ratio. This means that the rate for a 64-year-old can’t be more than three times (i.e., 300 percent) the rate for a 21-year-old.

•  Geographic area.

•  Family composition – with member-level rating applied. Instead of composite rating, each family member will be rated individually. Carriers can charge only for the three oldest children in the family who are under 21. For example, in a family of six, the rate would be the subscriber rate + spouse rate + the 0–21 rate x 3.

•  tobacco use (limited to 1.5:1 ratio).

Note: Health Net will not be factoring tobacco use into our rates.

Group health plans and health insurers may not apply a waiting period that exceeds 90 days. California law limits the waiting period to 60 days.

The annual cost-sharing incurred must not exceed the maximum out-of-pocket amounts of $6,350 / $12,700 for self-only and family coverage.

The annual deductible for small group plans may generally not exceed $2,000 for self-only coverage or $4,000 for family coverage (certain exceptions apply).

Plans may not impose any pre-existing condition exclusions.

Call Jeremy with questions – (310) 486-7625

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